Posted on March 5, 2015
Antimicrobial stewardship programs (ASPs) have clear benefits for hospitals and patients, but just as clearly have costs. What’s the real value proposition? Why should your hospital implement an antimicrobial stewardship program now?
ASPs improve patient outcomes. These programs help clinicians improve the quality of patient care and improve patient safety through increased infection cure rates, reduced treatment failures, and increased frequency of correct prescribing for therapy and prophylaxis.
They slow development of resistance: Over time, ASPs can reduce antimicrobial resistance and slow development of resistant organisms in your hospital and in your community.
ASPs shorten patient length of stay and associated costs by reducing the number of HAIs. On average, an HAI leads to 9.58 extra hospital days and $38,656 in largely non-reimbursable excess charges.1 Hospitals with robust antimicrobial stewardship programs also see lower legal costs associated with healthcare-associated infections (HAIs) and deaths.
Antimicrobial stewardship programs reduce pharmacy costs. On a hospital level, facilities that implement comprehensive ASPs consistently save $200,000 to $900,000 in direct costs per year.2 Much of this reduced cost comes from more appropriate use of antimicrobials in terms of bug/drug matches, proper duration of treatment, adjusted dosing for weight and renal status and recommended length of therapy as well as use of oral rather than intravenous antimicrobials.
Antimicrobial stewardship programs can improve your hospital’s reputation in the community. Hospitals must report specific HAIs to the National Healthcare Safety Network (NHSN). Now, consumers can view hospital HAI rates on the CMS Hospital Compare website. High rates may translate into loss of patients and revenue, as patients may choose to go to hospitals with lower reported infection rates.
Starting your program now will put you in a better position with regulators. Growing numbers of federal and states agencies require ASPs. Last year, the CDC formally recommended ASPs for all hospitals. The Centers for Medicare and Medicaid Services are expected to require that U.S. acute care, critical care and long-term care hospitals implement antimicrobial stewardship programs by the end of 2017. Additionally, in September 2014, California passed legislation requiring hospitals to implement physician-supervised multidisciplinary antimicrobial stewardship programs that comply with federal and professional organization recommendations.
You can avoid fines: With the increased focus on HAIs and MDROs, federal and state regulators have begun enforcing penalties for poor performance. In 2014, 721 hospitals saw Medicare reimbursements cut 1% for having high rates of HAIs and 2,610 hospitals were fined for having too many readmissions within a month of discharge, a problem frequently related to HAIs. Poor performing hospitals now have up to 5% of their Medicare reimbursements at risk. 3
Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003;290:1868-74.
IDSA/SHEA Guidelines for Antimicrobial Stewardship Programs http://www.journals.uchicago.edu/doi/pdf/10.1086/510393
Rau J. Medicare Cuts Payments to 721 Hospitals with the Highest Rates of Infections, Injuries. Kaiser Health News. December 18, 2014.